Topics in Geriatrics:Exercise and Depression in Older Adults
Objectives
Overview of prevalence of Depression in older adults
Physical Therapist role in Older population depression
Support the positive effects of exercise on depression
Exercise Recommendations
Overview of Prevalence of Depression in the Older Population The CDC has estimated that 15-20% of adults over the age 65 suffer from depression, which equals 7 million individuals in the United States (1). It is common for healthcare providers to also misdiagnose or ignore signs and symptoms that indicate an individual is suffering from depression (2). Signs and symptoms to be on the lookout for are:
Increased fatigue
Changes in appetite – overeating, loss of appetite
Irritability
Feelings of worthlessness/guilt
Feeling hopeless or increase in negative thoughts
Difficulty concentrating/poor judgement/decision making
Withdrawal from activities/hobbies
Changes in sleep patterns
Thoughts of suicide
Increase levels of pain
Factors that may influence the development of depression are: isolation, decreased independence, dementia, decreased functional abilities…etc (1) Adults who also are suffering from a chronic disease are at risk for developing depressive symptoms due to their condition affecting their function (2).
Physical Therapists Role in Depression in the Elderly “The US Preventative Task Force (USPTF) recommends that all individuals older than 60 years be periodically screened for depression. The APTA has set guidelines regarding care of older adults stating that a physical therapist should be able to “1. select and administer tests for cognition and depression (eg. Mini-Mental State Examination, Geriatric Depression Scale, Clock Drawing Test); 2. differentiate between depression, delirium, and dementia on the basis of symptoms and comorbidities; 3. adapt/modify communication and care delivery as needed; and 4. determine need for referral” (3).
A common screening tool which can be used by physical therapists is The Geriatric Depression Scale which is a 30-item questionnaire. This stool asks how an individual felt over the past week. A short form has been developed with includes 15 items (4). Access to screening tool : https://consultgeri.org/try-this/general-assessment/issue-4.pdf
Benefit of Exercise for Depression
Exercise has been found to increase endorphin and monoamine levels within the brain while simultaneously decreasing cortisol levels. Exercise has also been found to promote neurogenesis of the hippocampus and dendritic remodeling which and this effect has been found to be “ much stronger than that determined by antidepressant drugs) (4) Exercise also can be effective in improving quality of life by impacting feelings of well being and reduce negative thoughts while promoting a “sense of purpose” (5)
Some believe that the effects of exercise reduce feelings of depression in the elderly by increasing self efficacy and allowing the individual to achieve a “sense of mastery” (6).
Exercise Recommendations
The National Institute for Health and Clinical Excellence has suggested that “structured, supervised exercise programs” performed 3 times a week for 45 minutes to 1 hour at a low intensity can be used as an intervention for mild to moderate depression (5) The world health organization has given guidelines for physical activity in the elderly population to reduce the risk of depression, along with improve overall health. (7)
Either 150 minutes of moderate-intensity aerobic physical activity per week or 75 minutes of vigorous-intensity aerobic physical activity or combination.
Muscle-strengthening activities should be done at least 2 times per week.
Mura G, Carta MG. Physical Activity in Depressed Elderly. A Systematic Review. Clinical Practice and Epidemiology in Mental Health : CP & EMH. 2013;9:125-135. doi:10.2174/1745017901309010125.
Topics in Geriatrics: Exercise and Depression in Older Adults
Objectives
Overview of Prevalence of Depression in the Older Population
The CDC has estimated that 15-20% of adults over the age 65 suffer from depression, which equals 7 million individuals in the United States (1). It is common for healthcare providers to also misdiagnose or ignore signs and symptoms that indicate an individual is suffering from depression (2). Signs and symptoms to be on the lookout for are:
- Increased fatigue
- Changes in appetite – overeating, loss of appetite
- Irritability
- Feelings of worthlessness/guilt
- Feeling hopeless or increase in negative thoughts
- Difficulty concentrating/poor judgement/decision making
- Withdrawal from activities/hobbies
- Changes in sleep patterns
- Thoughts of suicide
- Increase levels of pain
Factors that may influence the development of depression are: isolation, decreased independence, dementia, decreased functional abilities…etc (1)Adults who also are suffering from a chronic disease are at risk for developing depressive symptoms due to their condition affecting their function (2).
Physical Therapists Role in Depression in the Elderly
“The US Preventative Task Force (USPTF) recommends that all individuals older than 60 years be periodically screened for depression. The APTA has set guidelines regarding care of older adults stating that a physical therapist should be able to “1. select and administer tests for cognition and depression (eg. Mini-Mental State Examination, Geriatric Depression Scale, Clock Drawing Test); 2. differentiate between depression, delirium, and dementia on the basis of symptoms and comorbidities; 3. adapt/modify communication and care delivery as needed; and 4. determine need for referral” (3).
A common screening tool which can be used by physical therapists is The Geriatric Depression Scale which is a 30-item questionnaire. This stool asks how an individual felt over the past week. A short form has been developed with includes 15 items (4).
Access to screening tool : https://consultgeri.org/try-this/general-assessment/issue-4.pdf
Benefit of Exercise for Depression
Exercise has been found to increase endorphin and monoamine levels within the brain while simultaneously decreasing cortisol levels. Exercise has also been found to promote neurogenesis of the hippocampus and dendritic remodeling which and this effect has been found to be “ much stronger than that determined by antidepressant drugs) (4) Exercise also can be effective in improving quality of life by impacting feelings of well being and reduce negative thoughts while promoting a “sense of purpose” (5)
Some believe that the effects of exercise reduce feelings of depression in the elderly by increasing self efficacy and allowing the individual to achieve a “sense of mastery” (6).
Exercise Recommendations
The National Institute for Health and Clinical Excellence has suggested that “structured, supervised exercise programs” performed 3 times a week for 45 minutes to 1 hour at a low intensity can be used as an intervention for mild to moderate depression (5)
The world health organization has given guidelines for physical activity in the elderly population to reduce the risk of depression, along with improve overall health. (7)
Additional Information
1. https://www.cdc.gov/aging/mentalhealth/depression.htm
2. https://www.nimh.nih.gov/health/publications/older-adults-and-depression/index.shtml
3. http://www.who.int/mediacentre/factsheets/fs381/en/
4. https://nihseniorhealth.gov/depression/aboutdepression/01.html
5. https://www.ncbi.nlm.nih.gov/pubmed/23619921
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